Request

Request form

Complete this form.

Company Name*
Your Name*
E-mail Address*
E-mail Address(Retype)*
Zip Code	( ex：999-9999 )
Country
Address1*
Address2
Telephone*	( ex：03-9999-9999 )
Fax	( ex：03-9999-9999 )
Mobile phone
Code	18060
Name	Video Gastroscope
Brand	OLYMPUS
Model	GIF-Q150X
Endorsement number
Status	Sold
Price
Comment	Work with CV-150/170 processor
Specification & Options	insertion tube 9.2mm channel size 2.8mm *working length 1030mm
Configuration
Condition	Patient ready
inquiry*	(1000characters)